A Surgical Case of Infective Endocarditis with Annular Abscess into Mitral Annulus Calcification

Masahiko Fujii＊	Kenji Mogi＊	Manabu Sakurai＊
Anan Nomura＊	Tomoki Sakata＊	Yoshiharu Takahara＊

（Division of Cardiovascular Surgery, Heart and Vascular Institute, Funabashi Municipal Medical Center, Funabashi, Japan）

A 79-year-old man, who had undergone aortic valve replacement due to severe aortic stenosis 2.5 years previously and permanent pacemaker implantation for sick sinus syndrome 2 months after aortic valve replacement, was admitted for congestive heart failure and suspicion of prosthetic valve endocarditis. However, he had a fever in spite of medical therapy, and transthoracic echocardiography revealed a 20mm vegetation on the posterior mitral valve leaflet. He underwent emergency surgery on a diagnosis of infective endocarditis. The intraoperative examination showed annular abscess on the calcified mitral annulus, and a part of abscess had disintegrated, from which the vegetation arose. We performed maximal possible debridement of the infected tissue and mitral annulus reconstruction with a bovine pericardium. Subsequently, mitral valve replacement and annulus reinforcement with a prosthetic valve collared with a bovine pericardium were performed to prevent perivalvular leakage. The patient showed no recurrence of infection and perivalvular leakage at 1.5 years of follow-up.

 

Jpn. J. Cardiovasc. Surg. 46:243-246（2017）

Keywords：infective endocarditis;mitral annular calcification;annular abscess